In Vivo Pelvic and Hip Joint Kinematics in Patients With Cam Femoroacetabular Impingement Syndrome: A Dual Fluoroscopy Study

Femoroacetabular impingement syndrome (FAIS) may alter the kinematic function of the hip, resulting in pain and tissue damage. Previous motion analysis studies of FAIS have employed skin markers, which are prone to soft tissue artifact and inaccurate calculation of the hip joint center. This may explain why the evidence linking FAIS with deleterious kinematics is contradictory. The purpose of this study was to employ dual fluoroscopy (DF) to quantify in vivo kinematics of patients with cam FAIS relative to asymptomatic, morphologically normal control participants during various activities. Eleven asymptomatic, morphologically normal controls and seven patients with cam FAIS were imaged with DF during standing, level walking, incline walking, and functional range of motion activities. Model-based tracking calculated the kinematic position of the hip by registering projections of three-dimensional computed tomography models with DF images. Patients with FAIS stood with their hip extended (mean [95% confidence interval], -2.2 [-7.4, 3.1]°, flexion positive), whereas controls were flexed (5.3 [2.6, 8.0]°; p = 0.013). Male patients with cam FAIS had less peak internal rotation than the male control participants during self-selected speed level-walking (-0.2 [-6.5, 6.1]° vs. -9.8 [-12.2, -7.3]°; p = 0.007) and less anterior pelvic tilt at heel-strike of incline (5°) walking (3.4 [-1.0, -7.9]° vs. 9.8 [6.4, 13.2]°; p = 0.032). Even during submaximal range of motion activities, such as incline walking, patients may alter pelvic motion to avoid positions that approximate the cam lesion and the acetabular labrum. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:823-833, 2020.